To prepare for your first appointment, please complete this questionnaire as complete and accurate as possible. The information collected allows us an initial analysis of your concerns and goals. All information given is treated confidentially and serves exclusively for the purpose of our work with you and your organization.

Our experience shows that a differentiated analysis of the current situation is the starting point for successful and sustainable changes. Therefore, we collect data that reflects various aspects of your personality and your professional and private situation.

Please take about 20 minutes and answer spontaneously. Unless otherwise stated, please refer to the period of the last three months.

Please fill out the form before your first appointment with us.

Instructions on filling in the form

· Please answer the questions in keywords in the text boxes below.
· Mandatory fields are marked by *.

Questions about your person

Your name*:

Address:

Date of birth:

Gender*:

female

male

Nationality:

Martial status:

Children (age, gender/none):

Size in cm:

cm

Weight in kg:

kg

Job:

Employment:

Title/Position:

Total time of employment:

Highest level of education:

Graduation year:

Coaching goals and motivation

Please click on the items that apply to you.

Leadership Advisory

Please Specify in keywords:

Transformation Advisory

Please Specify in keywords:

Executive Career Advisory

Please Specify in keywords:

Executive Team Alignment

Please Specify in keywords:

First 100 Days

Please Specify in keywords:

Generational Change

Please Specify in keywords:

Self-Development and Growth

Please Specify in keywords:

Health, Mindfulness and Resilience

Please Specify in keywords:

Work-Life Balance

Please Specify in keywords:

other, please specify

Please Specify in keywords:

Leadership Skills

Please rate the importance and your personal competence level of the following items. (on a scale from 1 - completely unimportant, to 10 - very important and from 1 - not yet developed, to 10 - fully developed and applied with ease)

Results Orientation

Importance

1

2

3

4

5

6

7

8

9

10

Competence

1

2

3

4

5

6

7

8

9

10

Strategic Orientation

Importance

1

2

3

4

5

6

7

8

9

10

Competence

1

2

3

4

5

6

7

8

9

10

Collaboration and Influence

Importance

1

2

3

4

5

6

7

8

9

10

Competence

1

2

3

4

5

6

7

8

9

10

Team Leadership

Importance

1

2

3

4

5

6

7

8

9

10

Competence

1

2

3

4

5

6

7

8

9

10

Change Leadership

Importance

1

2

3

4

5

6

7

8

9

10

Competence

1

2

3

4

5

6

7

8

9

10

Organizational Development

Importance

1

2

3

4

5

6

7

8

9

10

Competence

1

2

3

4

5

6

7

8

9

10

Inclusiveness

Importance

1

2

3

4

5

6

7

8

9

10

Competence

1

2

3

4

5

6

7

8

9

10

Resources

Please rate the following items for you personally on a scale from 1 (not available) to 10 (excellent).

Judgment

1

2

3

4

5

6

7

8

9

10

Commitment

1

2

3

4

5

6

7

8

9

10

Determination

1

2

3

4

5

6

7

8

9

10

Insight

1

2

3

4

5

6

7

8

9

10

Focus

1

2

3

4

5

6

7

8

9

10

Goal Clarity

1

2

3

4

5

6

7

8

9

10

Openness

1

2

3

4

5

6

7

8

9

10

Agility

1

2

3

4

5

6

7

8

9

10

Detail Orientation

1

2

3

4

5

6

7

8

9

10

Health

1

2

3

4

5

6

7

8

9

10

Resilience

1

2

3

4

5

6

7

8

9

10

Ownership

1

2

3

4

5

6

7

8

9

10

Manage Uncertainty

1

2

3

4

5

6

7

8

9

10

Manage Complexity

1

2

3

4

5

6

7

8

9

10

Creativity

1

2

3

4

5

6

7

8

9

10

Thinking Big

1

2

3

4

5

6

7

8

9

10

Coaching topics

Please describe your primary concerns (or problems) in short sentences or keywords.Since when do you have this concern or problem?Why did you decide to seek support now?Who else is affected or involved besides you and how does the problem affect others?What have you already tried to achieve a change? What worked and which attempts did not work and why?How would you realize that a positive change is beginning?Please write down specific questions that you have regarding your desire to change.

Additional personal information

How much do you enjoy working in your current job? (Scale from 1 no joy at all to 10 very much joy)

1

2

3

4

5

6

7

8

9

10

Please briefly describe why you have rated this item with 5 or less?

Are there any stressful factors in your workplace?

Yes

No

Please describe these factors briefly.

Does your work include business travel?

Yes

No

What percentage of your working time is used to travel?

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Have you made use of coaching before?

Yes

No

Please describe briefly when and where, and what the main topics were.

Please rate the following items on a scale of 1 (very bad) to 10 (excellent):

Sleep

1

2

3

4

5

6

7

8

9

10

Please briefly describe why you have rated this item with 5 or less?

Nutrition

1

2

3

4

5

6

7

8

9

10

Please briefly describe why you have rated this item with 5 or less?

Movement

1

2

3

4

5

6

7

8

9

10

Please briefly describe why you have rated this item with 5 or less?

Health

1

2

3

4

5

6

7

8

9

10

Please briefly describe why you have rated this item with 5 or less?

Are you currently in a relationship?

Yes

No

Relationship Quality

1

2

3

4

5

6

7

8

9

10

Please briefly describe why you have rated this item with 5 or less?

Duration of relationship:

Do you live alone or with another person(s)?

Alone

Partner/Spouse

Family

Roommate

Do you currently attend relatives in need of care?

Yes

No

Since when and to what extent?

Have you experienced any recent stress, grief, major changes or losses?

Yes

No

Please describe briefly:Which events are you still involved in and since when?

Are there any moods, symptoms, or other specific issues that you consider important and have not yet been otherwise inquired?

Yes

No

Please describe briefly.

Are you ready to open up to new perceptions of your personality and your personal environment in coaching?

Yes

No

Are you able to comply with agreements?

Yes

No

Are you physically, mentally and financially capable and willing to invest in personal development through individual coaching?

Yes

No

And finally: How do you spend your time?

How much time per day do you spend on the following activities on weekdays (WD) and weekends (WE)?
(please refer to a "standard week" of the last two months)

weekdays

weekends

Work

Exercise

Media consumption

Household / Family

Friends

Art / Culture

Eat out

Other

if other, please specify.

Submit

EXCELLENCE IN MIND – LIESENFELD EXECUTIVE COACHING GMBH

The Liesenfeld Executive Coaching GmbH with its guiding principle EXCELLENCE IN MIND is an international coaching and consulting company, established in 1999. It is our mission to guide people towards personal maturity and professional excellence. With our own research sector (www.liesenfeld-institute.com), we work on a profound neuroscientific and personality psychological basis. We support companies and their executives with a major focus on authentic leadership, generation change in family businesses and transformational change. Core values informing our approach and manner of working are a fundamental stance of appreciation, professional excellence, growth and freedom.

OFFICE BERLIN

The Liesenfeld Executive Coaching GmbH (previously Corporate Coaching Company) with its guiding principle EXCELLENCE IN MIND is an international coaching and consulting company, established in 1999. It is our mission to guide people towards personal maturity and professional excellence. With our own research sector (www.liesenfeld-institute.com), we work on a profound neuroscientific and personality psychological basis. We support companies and their executives with a major focus on authentic leadership, generation change in family businesses and transformational change. Core values informing our approach and manner of working are a fundamental stance of appreciation, professional excellence, growth and freedom.